<html>
<head>
<title>Untitled Document</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>

<body bgcolor="#FFFFFF" text="#000000">


      <form name="registerForm" method="POST" action="register.php">
        <p>Email 
          <input type="text" name="mail">
        </p>
        <p> First Name 
          <input type="text" name="name">
          Last Name 
          <input type="text" name="textfield3">
        </p>
        <p> Date of Birth 
          <input type="text" name="textfield4">
          Country 
          <input type="text" name="textfield5">
        </p>
        <p>Address 
          <input type="text" name="textfield6">
          Number 
          <input type="text" name="textfield7">
        </p>
        <p> Zip Code 
          <input type="text" name="textfield8" >
          City 
          <input type="text" name="textfield9">
        </p>
        <p> Credit Card 
          <select name="select">
            <option>Amex</option>
            <option>Visa</option>
            <option>MasterdCard</option>
          </select>
          Number 
          <input type="text" name="textfield10">
        </p>
        <p> 
          <input type="reset" name="Reset" value="Clear">
          <input type="submit" name="Submit" value="Register">
        </p>
      </form>
    
</body>
</html>
